WASHINGTON, D.C. – A new report by the American Cancer Society Cancer Action Network (ACS CAN) found that over 70% of commercially-insured patients encountered out-of-pocket expenses for follow-up breast cancer diagnostic tests in 2023. These follow-up tests, such as a diagnostic mammogram, MRI, ultrasound or biopsy, are medically recommended next steps to determine if an individual may or may not have cancer; however, barriers like cost can keep people from getting them.
While screening mammograms are free to most insured women starting at age 40, follow-up testing often results in out-of-pocket cost sharing for patients. The report showed the average share of out-of-pocket costs across procedures varied across states, with North Dakota having the highest costs (51.8%) followed by South Dakota (48.6%). Northeastern states such as Delaware (9.0%) and New York (12.9%) had the lowest share of out-of-pocket costs.
“Out-of-pocket cost sharing is a significant barrier for those individuals who need access to multiple early detection services in order to find cancer at an earlier stage when treatment is more effective,” said Lisa Lacasse, president of ACS CAN. “These additional expenses can lead to delayed or even skipped medically necessary procedures resulting in potentially life-threatening consequences. Removing cost sharing for each intervention in the screening process is a critical step toward ending cancer as we know it, for everyone.”
Due to these costs, many patients choose to delay receiving follow-up diagnostic tests which can result in later-stage cancer diagnoses and higher healthcare costs. In 2024, more than 1 million women aged 40 to 75 were estimated to experience a delay in follow-up testing and imaging due to associated costs. The report also determined that out-of-pocket costs are having an impact on the completion of future screening mammograms. Approximately 378,000 more women were likely to skip future mammograms (in 2024) due to fear of subsequent out-of-pocket cost sharing from follow-up diagnostic tests
The report also showed that the elimination of out-of-pocket cost sharing for follow-up tests could prevent more than 7,500 later-stage diagnoses and ultimately save the U.S. an estimated $2.2 billion in lifetime breast cancer treatment costs.
Despite some states adopting legislation eliminating out-of-pocket costs for post-mammogram diagnostic testing, these protections are not available to every woman. Patients living in other states or those enrolled in non-state-regulated health plans still face significant costs.